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Will Illinois' Home Birth Safety Bill Pass?

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January 5, 2011

January 5, 2011
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It's the bill advocates are calling "the solution to the Illinois home birth maternity care crisis" and some have been waiting 30 years for its passage.

The Illinois Home Birth Safety Act (SB 3712), sponsored by State Representative Robyn Gable, will most likely come up for a vote in the Illinois General Assembly this week, and midwifery advocates are hopeful. If passed, it would make Illinois the 28th state in the country to legally authorize Certified Professional Midwives (CPMs) to practice.

Advocates for the bill in Illinois want, simply, to be able to meet the demand, by pregnant women and their families, for high-quality, licensed, certified professional midwives throughout the state. Currently, there are only five among 102 Illinois counties which are served by "legally recognized" home-birth practices - these are run by nurse-midwives (CNMs) or physicians, leaving most women throughout the state to access unregulated midwives, operating underground, if a homebirth is what they're after.

In states from Florida to Washington State, access to licensed, state-regulated CPMs has in fact reduced overall maternity care costs to the states and, in some cases, improved health outcomes for mother and newborn. Study after study around the world, and published in peer-reviewed journals, has shown that planned homebirth, with a licensed midwife, is equally as safe as a hospital birth for women with a healthy pregnancy.

So, state by state midwifery advocates must knock down the barriers to providing the midwifery model of care to women seeeking an out-of-hospital birth.

Michelle Breen, the Acting President for the Coalition for Illinois Midwifery says of the necessity to pass the bill and legalize home birth midwifery care,

"The biggest issue is that when women choose to have a homebirth we want them to be able to find a licensed provider. Women may get lucky and find one [in Illinois] but it’s up to the family to decide if the midwife is qualified. There is no state regulation or licensure right now that families can trust."

Breen says that because of an "extreme shortage of licensed providers" and "the high demand for home birth services, women are faced with sub-optimal care options." Some women resort to birthing at home, unassisted. This all amounts, says Breen, to a "hole in our maternity care delivery system."

It's hard to argue that allowing women to either access under par, unregulated care or to birth at home with absolutely no skilled attendant present is acceptable for the women of Illinois. The state has been harsher on certified professional midwives than any other. More midwives have been prosecuted under Illiinois law for operating illegally than in any other state. It drives away the licensed, regulated, experienced providers and leaves pregnant and birthing women open to dangerous conditions.

Breen notes that women and their families have experienced particularly difficult issues on occasions when a woman needs to be transferred to the hospital. Women have been harassed by hospital staff; doctors and nurses play "investigator" to try and determine who their midwife was, instead of focusing their attention on the woman's pressing medical needs. In one case, a mother was reported to Child Protective Services citing medical neglect based on the decision to have a home birth, rather than the suggested cesarean section.

All of this is to say that Illinois is a state that desperately needs a revision of its laws related to maternity care and maternity care practitioners. SB3712 not only licenses home birth practices by licensing professional midwives under the Department of Financial and Professional Regulation. It also creates the Illinois Midwifery Board; and "sets forth provisions concerning qualifications, grounds for disciplinary action, and administrative procedures."

According to the Coalition for Illinois Midwifery, support for legislating midwifery in the state through the Home Birth Safety Bill is broad and includes the Illinois Public Health Association, the American Public Health Association, the Illinois Society for Advanced Practice Nursing, Illinois Chapter of the American Colleges of Nurse-Midwives, Illinois Maternal & Child Health Coalition and Health Medicine Policy Research Group.

Key components of the bill were, in fact, written by the Illinois Society for Advanced Practice Nursing and the Illinois Nurses Association. These sections include information on educational requirements for CPMs in the state, medications and protocol for physicial referrals.

Which groups are conspicuously absent from this list? That would be the American Medical Association (AMA), the American College of Obstetrics and Gynecology (ACOG) and the Illinois State Medical Society (ISMS). That's because both the AMA and ACOG are categorically opposed to planned homebirth, each with their own official position statements outlining why.

Illinois has had a particularly challenging - and extensive - road when it comes to passing legislation making home birth safer and expanding women's options for childbirth. The AMA is based in Illinois and the ISMS has disseminated some of the angriest - and seemingly propagandistic - information opposing home birth, and specifically the Home Birth Act.

In an action alert about SB3712 distributed by ISMS, the group calls the bill "extremely dangerous" saying "It must be stopped!" Despite the fact that 27 states, thus far, have legalized licensed, certified professional midwifery for maternity care, the state medical board has called out this bill for its "extreme danger." But why?

They note that the bill "would allow these midwives to take histories, perform physicals, provide prenatal care, dispense drugs, treat hemorrhages and other emergencies, and treat the infant and woman postpartum." The ISMS does not note that other state legislatures have deemed all of these services legal and safe when performed by CPMs; all of which certified midwives must be trained to do and which, under this law, would be tightly regulated.

Susan Jenkins, lobbyist of The Big Push for Midwives, says that the action alert is also flat out wrong. Citing the alert's language that midwives would be able to "prescribe drugs" to women, Jenkins tells RH Reality Check that the information is incorrect. The bill would allow CPMs to dispense certain medication but, again, these sections of the bill were written by the medical community, somewhat diminishing the ISMS' outrage. The ISMS was invited by the Coalition for Illinois Midwifery to sit on the ad hoc committee which re-wrote these specific parts of the bill, in fact. They declined.

Michelle Breen asks, "Why would doctors care so much about what amounts to 1 percent of the births?" It may be because the medical societies have held the bulk of the power when it comes to making medical care decisions, and they are not prepared to decentralize. Legislators, says Breen, look to the medical society for advice on medical issues. But CPMs operate outside of a traditional medical model, preferring to see healthy pregnancies and birth as normal processes, not as necessarily medical conditions or situations requiring automatic medical interventions. And because many women feel the same way, Breen says, it's critical that they are offered the out-of-hospital care they seek.

"Statements from IL ACOG usually focus on the wonderful care women can get in the hospital. The group never answers the question of how do we care for healthy women who simply will not go to a hospital to deliver a baby...They have had 30 years to come up with a solution to this problem. Not only have they not done so, they have demonstrated zero interest in doing so and they have done everything they can to block efforts by consumer groups, nursing groups and public health groups who are earnestly seeking a solution."

The women of Illinois who seek out-of-hospital births, and certified midwives who wish to operate above ground as licensed and regulated profesionals, deserve a solution, however. As Audrey Stillerman, a family physician in Illinois and Judy Norisigian, executive director of Our Bodies, Ourselveswrite in an editorial in the Springfield, IL State-Journal Register, it's past time to ensure safe home birth availability in Illinois, the way it's ensured in states around the country,

"Over half the states regulate home birth midwives. No state has ever decided to rescind a home birth regulatory law."

This post was originally published at RH Reality Check, a site of news, community and commentary for reproductive health and justice